Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1064 | TX |
NPI | 1033114822 |
---|---|
Provider Name | Dr. James Michael Jacobs |
First Address | Katy, TX 77494-2046 |
Second Address | Katy, TX 77494-2046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018651201 | MEDICAID PIN (01) | TX |
081651201 | (05) | TX |
5476250001 | MEDICARE NSC (01) | TX |